Association of physical activity with risk of chronic kidney disease in China:A population-based cohort study

Background:Information on the association between physical activity(PA)and the risk of chronic kidney disease(CKD)is limited.We aimed to explore the associations of total,domain-specific,and intensity-specific PA with CKD and its subtypes in China.Methods:The study included 475,376 adults from the China Kadoorie Biobank aged 30-79 years during 2004-2008 at baseline.An interviewer-administered questionnaire was used to collect the information about PA,which was quantified as metabolic equivalent of task hours per day(MET-h/day)and categorized into 4 groups based on quartiles.Cox regression was used to analyze the association between PA and CKD risk.Results:During a median follow-up of 12.1 years,5415 incident CKD cases were documented,including 1159 incident diabetic kidney disease(DKD)cases and 362 incident hypertensive nephropathy(HTN)cases.Total PA was inversely associated with CKD risk,with an adjusted hazard ratio(HR,95%confidence interval(95%CI))of 0.83(0.75-0.92)for incident CKD in the highest quartile of total PA as compared with participants in the lowest quartile.Similar results were observed for risk of DKD and HTN,and the corresponding HRs(95%CIs)were 0.75(0.58-0.97)for DKD risk and 0.56(0.37-0.85)for HTN risk.Increased nonoccupational PA,low-intensity PA,and moderate-to-vigorous-intensity PA were significantly associated with a decreased risk of CKD,with HRs(95%CIs)of 0.80(0.73-0.88),0.85(0.77-0.94),and 0.85(0.76-0.95)in the highest quartile,respectively.Conclusion:PA,including nonoccupational PA,low-intensity PA,and moderate-to-vigorous-intensity PA,was inversely associated with the risk of CKD,including DKD,HTN,and other CKD,and such associations were dose dependent.

Uphold the Original Intention and Work together for Future Development——Speech at the 35^(th)Anniversary Symposium of BES

Time flies,in the blink of an eye,it is already 2023.The journal Biomedical and Environmental Sciences(BES)has been established for thirty-five years.Today,I am honored to participate in the BES’s 35^(th) anniversary symposium,organized by the Chinese Center for Disease Control and Prevention(China CDC).Seeing Director Hongbing Shen,Deputy Director Xiaoming Shi,along colleagues from the center’s affiliated units and departments,as well as fellow researchers,we have come together for this symposium under the theme of“Looking back and looking forward”,I am not only deeply appreciative and thankful,but also envisioning a bright future for BES in the next 35 years.I would like to share my thoughts and hopes under the theme of“Review and Development”.

Associations of polygenic risk scores with risks of stroke and its subtypes in Chinese

Background and purpose Previous studies,mostly focusing on the European population,have reported polygenic risk scores(PRSs)might achieve risk stratification of stroke.We aimed to examine the association strengths of PRSs with risks of stroke and its subtypes in the Chinese population.Methods Participants with genome-wide genotypic data in China Kadoorie Biobank were split into a potential training set(n=22191)and a population-based testing set(n=72150).Four previously developed PRSs were included,and new PRSs for stroke and its subtypes were developed.The PRSs showing the strongest association with risks of stroke or its subtypes in the training set were further evaluated in the testing set.Cox proportional hazards regression models were used to estimate the association strengths of different PRSs with risks of stroke and its subtypes(ischaemic stroke(IS),intracerebral haemorrhage(ICH)and subarachnoid haemorrhage(SAH)).Results In the testing set,during 872919 person-years of follow-up,8514 incident stroke events were documented.The PRSs of any stroke(AS)and IS were both positively associated with risks of AS,IS and ICH(p<0.05).The HR for per SD increment(HR_(SD))of PRSAS was 1.10(95%CI 1.07 to 1.12),1.10(95%CI 1.07 to 1.12)and 1.13(95%CI 1.07 to 1.20)for AS,IS and ICH,respectively.The corresponding HR_(SD) of PRS_(IS) was 1.08(95%CI 1.06 to 1.11),1.08(95%CI 1.06 to 1.11)and 1.09(95%CI 1.03 to 1.15).PRS_(ICH) was positively associated with the risk of ICH(HR_(SD)=1.07,95%CI 1.01 to 1.14).PRSS_(AH) was not associated with risks of stroke and its subtypes.The addition of current PRSs offered little to no improvement in stroke risk prediction and risk stratification.Conclusions In this Chinese population,the association strengths of current PRSs with risks of stroke and its subtypes were moderate,suggesting a limited value for improving risk prediction over traditional risk factors in the context of current genome-wide association study under-representing the East Asian population.

Prevalence and Risk Factors for Chronic Obstructive Pulmonary Disease Among Adults Aged 50 and Above-10 CKB Study Areas,China,2020–2021

What is already known about this topic?The prevalence of COPD in Chinese individuals aged 50 years and above was obviously higher than that in younger adults,but the risk factors for this age group were unclear.What is added by this report?The prevalence was estimated at 12.8%and 5.7%for males and females over 50 in 2020–2021,with confirmed risk factors of cigarette smoking,a family history of respiratory diseases,respiratory symptoms,and a history of cough or respiratory diseases during childhood.What are the implications for public health practice?The findings may help clinicians and the public identify individuals at high risk of COPD and take targeted measures in a timely manner.

The Association Between Preserved Ratio Impaired Spirometry and Mortality –– 10 CKB Study Areas, China, 2004–2022

What is already known about this topic?China has the world’s most significant public health and economic burden of chronic respiratory disease.However,the association between preserved ratio impaired spirometry(PRISm)and mortality risk is unknown.What is added by this report?The PRISm group exhibited a 37%higher risk of allcause mortality than the normal group,and the risks of death from cardiovascular diseases,neoplasms,respiratory diseases,and infectious and parasitic diseases were also increased in PRISm.Moreover,the presence of respiratory symptoms or disease was associated with an increased risk of mortality in PRISm.What are the implications for public health practice?It is imperative to enhance public awareness of PRISm and to implement measures to facilitate the regression of PRISm toward normal lung function.

Multimorbidity patterns and association with mortality in 0.5 million Chinese adults

Background:Few studies have assessed the relationship between multimorbidity patterns and mortality risk in the Chinese population.We aimed to identify multimorbidity patterns and examined the associations of multimorbidity patterns and the number of chronic diseases with the risk of mortality among Chinese middle-aged and older adults.Methods:We used data from the China Kadoorie Biobank and included 512,723 participants aged 30 to 79 years.Multimorbidity was defined as the presence of two or more of the 15 chronic diseases collected by self-report or physical examination at baseline.Multimorbidity patterns were identified using hierarchical cluster analysis.Cox regression was used to estimate the associations of multimorbidity patterns and the number of chronic diseases with all-cause and cause-specific mortality.Results:Overall,15.8%of participants had multimorbidity.The prevalence of multimorbidity increased with age and was higher in urban than rural participants.Four multimorbidity patterns were identified,including cardiometabolic multimorbidity(diabetes,coronary heart disease,stroke,and hypertension),respiratory multimorbidity(tuberculosis,asthma,and chronic obstructive pulmonary disease),gastrointestinal and hepatorenal multimorbidity(gallstone disease,chronic kidney disease,cirrhosis,peptic ulcer,and cancer),and mental and arthritis multimorbidity(neurasthenia,psychiatric disorder,and rheumatoid arthritis).During a median of 10.8 years of follow-up,49,371 deaths occurred.Compared with participants without multimorbidity,cardiometabolic multimorbidity(hazard ratios[HR]=2.20,95%confidence intervals[CI]:2.14-2.26)and respiratory multimorbidity(HR=2.13,95%CI:1.97-2.31)demonstrated relatively higher risks of mortality,followed by gastrointestinal and hepatorenal multimorbidity(HR=1.33,95%CI:1.22-1.46).The mortality risk increased by 36%(HR=1.36,95%CI:1.35-1.37)with every additional disease.Conclusion:Cardiometabolic multimorbidity and respiratory multimorbidity posed the highest threat on mortality risk and deserved particular attention in Chinese adults.

Associations of muscle mass,strength,and quality with all-cause mortality in China:a population-based cohort study

Background It remains unclear about the association of muscle mass,strength,and quality with death in the general Chinese population of diverse economical and geographical backgrounds.The present study aimed to comprehensively examine such associations across different regions in China.Methods Based on the China Kadoorie Biobank study,the present study included 23,290 participants who were aged 38 to 88 years and had no prevalent cardiovascular diseases or cancer.Muscle mass and grip strength were measured using calibrated instruments.Arm muscle quality was defined as the ratio of grip strength to arm muscle mass.Low muscle mass,grip strength,and arm muscle quality were defined as the sex-specific lowest quintiles of muscle mass index,grip strength,and arm muscle quality,respectively.Cox proportional hazards models yielded hazard ratios(HRs)and 95%confidence intervals(CIs)for risks of all-cause mortality in relation to muscle mass,strength,and quality.Results During a median follow-up of 3.98 years,739 participants died.The HR(95%CI)of all-cause mortality risk was 1.28(1.08–1.51)for low appendicular muscle mass index,1.38(1.16–1.62)for low total muscle mass index,1.68(1.41–2.00)for low grip strength,and 1.41(1.20–1.66)for low arm muscle quality in models adjusted for sociodemographic characteristics,lifestyle factors,and medical histories.Conclusion Low muscle mass,grip strength,and arm muscle quality are all associated with short-term increased risks of mortality,indicating the importance of maintaining normal muscle mass,strength,and quality for general Chinese adults.

High performance computing of DGDFT for tens of thousands of atoms using millions of cores on Sunway TaihuLight

High performance computing(HPC)is a powerful tool to accelerate the Kohn–Sham density functional theory(KS-DFT)calculations on modern heterogeneous supercomputers.Here,we describe a massively parallel implementation of discontinuous Galerkin density functional theory(DGDFT)method on the Sunway Taihu Light supercomputer.The DGDFT method uses the adaptive local basis(ALB)functions generated on-the-fly during the self-consistent field(SCF)iteration to solve the KS equations with high precision comparable to plane-wave basis set.In particular,the DGDFT method adopts a two-level parallelization strategy that deals with various types of data distribution,task scheduling,and data communication schemes,and combines with the master–slave multi-thread heterogeneous parallelism of SW26010 processor,resulting in large-scale HPC KS-DFT calculations on the Sunway Taihu Light supercomputer.We show that the DGDFT method can scale up to 8,519,680 processing cores(131,072 core groups)on the Sunway Taihu Light supercomputer for studying the electronic structures of twodimensional(2 D)metallic graphene systems that contain tens of thousands of carbon atoms.

Essential role of medicine and food homology in health and wellness

Traditional Chinese medicine(TCM)is an ancient healing system that has been practiced for thousands of years in China and other East Asian countries.According to the TCM theory,medicine and food share the same origin and may have the same functions in the prevention and treatment of various health conditions.This is how the concept of medicine and food homology is developed and popularized.

Development of a prediction model to identify undiagnosed chronic obstructive pulmonary disease patients in primary care settings in China

Background:At present,a large number of chronic obstructive pulmonary disease(COPD)patients are undiagnosed in China.Thus,this study aimed to develop a simple prediction model as a screening tool to identify patients at risk for COPD.Methods:The study was based on the data of 22,943 subjects aged 30 to 79 years and enrolled in the second resurvey of China Kadoorie Biobank during 2012 and 2013 in China.We stepwisely selected the predictors using logistic regression model.Then we tested the model validity through P-P graph,area under the receiver operating characteristic curve(AUROC),ten-fold cross validation and an external validation in a sample of 3492 individuals from the Enjoying Breathing Program in China.Results:The final prediction model involved 14 independent variables,including age,sex,location(urban/rural),region,educational background,smoking status,smoking amount(pack-years),years of exposure to air pollution by cooking fuel,family history of COPD,history of tuberculosis,body mass index,shortness of breath,sputum and wheeze.The model showed an area under curve(AUC)of 0.72(95%confidence interval[CI]:0.72-0.73)for detecting undiagnosed COPD patients,with the cutoff of predicted probability of COPD=0.22,presenting a sensitivity of 70.13%and a specificity of 62.25%.The AUROC value for screening undiagnosed patients with clinically significant COPD was 0.68(95%CI:0.66-0.69).Moreover,the ten-fold cross validation reported an AUC of 0.72(95%CI:0.71-0.73),and the external validation presented an AUC of 0.69(95%CI:0.68-0.71).Conclusion:This prediction model can serve as a first-stage screening tool for undiagnosed COPD patients in primary care settings.

Genetic and healthy lifestyle factors in relation to the incidence and prognosis of severe liver disease in the Chinese population

Background:Severe liver disease(SLD),including cirrhosis and liver cancer,constitutes a major disease burden in China.We aimed to examine the association of genetic and healthy lifestyle factors with the incidence and prognosis of SLD.Methods:The study population included 504,009 participants from the prospective China Kadoorie Biobank aged 30-79 years.The individuals were from 10 diverse areas in China without a history of cancer or liver disease at baseline.Cox regression was used to estimate adjusted hazard ratios(HRs)for incident SLD and death after SLD diagnosis associated with healthy lifestyle factors(smoking,alcohol,physical activity,and central adiposity).Additionally,the contribution of genetic risk for hepatitis B virus(HBV,assessed by genetic variants in major histocompatibility complex,class II,DP/DQ[HLA-DP/DQ]genes)was also estimated.Results:Compared with those with 0-1 healthy lifestyle factor,participants with 2,3,and 4 factors had 12%(HR 0.88[95%confidence interval[CI]0.85,0.92]),26%(HR 0.74[95%CI:0.69,0.79]),and 44%(HR 0.56[95%CI:0.48,0.65])lower risks of SLD,respectively.Inverse associations were observed among participants with both low and high genetic risks(HR per 1-point increase 0.83[95%CI:0.74,0.94]and 0.91[95%CI:0.82,1.02],respectively;P_(interaction)=0.51),although with a non-significant trend among those with a high genetic risk.Inverse associations were also observed between healthy lifestyle factors and liver biomarkers regardless of the genetic risk.Despite the limited power,healthy lifestyle factors were associated with a lower risk of death after incident SLD among participants with a low genetic risk(HR 0.59[95%CI:0.37,0.96]).Conclusions:Lifestyle modification may be beneficial in terms of lowering the risk of SLD regardless of the genetic risk.Moreover,it is also important for improving the prognosis of SLD in individuals with a low genetic risk.Future studies are warranted to examine the impact of healthy lifestyles on SLD prognosis,particularly among individuals with a high genetic risk.

Minimal improvement in coronary artery disease risk prediction in Chinese population using polygenic risk scores:evidence from the China Kadoorie Biobank

Background:Several studies have reported that polygenic risk scores(PRSs)can enhance risk prediction of coronary artery disease(CAD)in European populations.However,research on this topic is far from sufficient in non-European countries,including China.We aimed to evaluate the potential of PRS for predicting CAD for primary prevention in the Chinese population.Methods:Participants with genome-wide genotypic data from the China Kadoorie Biobank were divided into training(n=28,490)and testing sets(n=72,150).Ten previously developed PRSs were evaluated,and new ones were developed using clumping and thresholding or LDpred method.The PRS showing the strongest association with CAD in the training set was selected to further evaluate its effects on improving the traditional CAD risk-prediction model in the testing set.Genetic risk was computed by summing the product of the weights and allele dosages across genome-wide single-nucleotide polymorphisms.Prediction of the 10-year first CAD events was assessed using hazard ratios(HRs)and measures of model discrimination,calibration,and net reclassification improvement(NRI).Hard CAD(nonfatal I21-I23 and fatal I20-I25)and soft CAD(all fatal or nonfatal I20-I25)were analyzed separately.Results:In the testing set,1214 hard and 7201 soft CAD cases were documented during a mean follow-up of 11.2 years.The HR per standard deviation of the optimal PRS was 1.26(95%CI:1.19-1.33)for hard CAD.Based on a traditional CAD risk prediction model containing only non-laboratory-based information,the addition of PRS for hard CAD increased Harrell’s C index by 0.001(-0.001 to 0.003)in women and 0.003(0.001 to 0.005)in men.Among the different high-risk thresholds ranging from 1%to 10%,the highest categorical NRI was 3.2%(95%CI:0.4-6.0%)at a high-risk threshold of 10.0%in women.The association of the PRS with soft CAD was much weaker than with hard CAD,leading to minimal or no improvement in the soft CAD model.Conclusions:In this Chinese population sample,the current PRSs minimally changed risk discrimination and offered little improvement in risk stratification for soft CAD.Therefore,this may not be suitable for promoting genetic screening in the general Chinese population to improve CAD risk prediction.

中国成人糖尿病、血糖与结直肠癌发病率:针对50万人的前瞻性研究

背景糖尿病可致结直肠癌(CRC)的发病风险升高。糖尿病病程和非糖尿病患者的血糖与CRC发病风险之间的相关性仍不清楚。方法2004至2008年前瞻性中国Kadoofe Biobank研究从10个不同地区纳入了512 713名受试者。在10年随访期间,在基线无癌症史的510 136名受试者中共记录有3 024例新发CRC病例(1 745例结肠癌,1 716例直肠癌)。应用Cox回归分析对糖尿病(入组前诊断或筛查发现的)或无糖尿病病史者随机血糖(RPG)水平与CRC发病相关性的校正风险比(HR)进行估计。结果基线时,共有5.8%的受试者患有糖尿病。糖尿病患者发生CRC的校正HR为1.18(95%可信区间1.04~1.33),且发生结肠癌与直肠癌的风险相当[1.19(1.01~1.39)比1.14(0.96~1135)]。这些患者发生CRC的HR随糖尿病病程的延长而下降(趋势P值为0.03)。在入组前无糖尿病的受试者中,其RPG水平与CRC发病呈正相关,基线RPG每升高1 mmol/L其发生CRC的校正HR为1.04(1.02~1.05),且发生结肠癌与直肠癌的风险亦相当[1.03(1.01~1.05)比1.04(1.02~1.06)]。在男性中,糖尿病和RPG与CRC发病风险的相关性高于女性,但其差异无统计学意义(异质性检验的P值分别为0.3和0.2)。讨论在中国成年人中,未诊断糖尿病者其糖尿病和升高的血糖水平与CRC发病风险升高相关。

Establishing a non-hydrostatic global atmospheric modeling system at3-km horizontal resolution with aerosol feedbacks on the Sunway supercomputer of China

During the era of global warming and highly urbanized development,extreme and high impact weather as well as air pollution incidents influence everyday life and might even cause the incalculable loss of life and property.Despite the vast development of atmospheric models,there still exist substantial numerical forecast biases objectively.To accurately predict extreme weather,severe air pollution,and abrupt climate change,numerical atmospheric model requires not only to simulate meteorology and atmospheric compositions simultaneously involving many sophisticated physical and chemical processes but also at high spatiotemporal resolution.Global integrated atmospheric simulation at spatial resolutions of a few kilometers remains challenging due to its intensive computational and input/output(I/O)requirement.Through multi-dimension-parallelism structuring,aggressive and finer-grained optimizing,manual vectorizing,and parallelized I/O fragmenting,an integrated Atmospheric Model Across Scales(iAMAS)was established on the new Sunway supercomputer platform to significantly increase the computational efficiency and reduce the I/O cost.The global 3-km atmospheric simulation for meteorology with online integrated aerosol feedbacks with iAMAS was scaled to 39,000,000 processor cores and achieved the speed of 0.82 simulation day per hour(SDPH)with routine I/O,which enabled us to perform 5-day global weather forecast at 3-km horizontal resolution with online natural aerosol impacts.The results demonstrate the promising future that the increasing of spatial resolution to a few kilometers with online integrated aerosol feedbacks may significantly improve the global weather forecast.

Association between fresh fruit consumption and the risk of chronic obstructive pulmonary disease-related hospitalization and death in Chinese adults:A prospective cohort study

Background:Existing evidence suggests that fruit consumption is a significant influencing factor for chronic obstructive pulmonary disease(COPD),but this is unclear in the Chinese population.We examined the association of fresh fruit consumption with the risk of COPD-related hospitalization and death in a nationwide,population-based prospective cohort from China.Methods:Between 2004 and 2008,the China Kadoorie Biobank recruited>0.5 million adults aged 30 to 79 years from ten diverse regions across China.After excluding individuals diagnosed with major chronic diseases and prevalent COPD,the prospective analysis included 421,428 participants.Cox regression was used to calculate the hazard ratios(HRs)for the association between fresh fruit consumption and risk of COPD-related hospitalization and death,with adjustment for established and potential confounders.Results:During a mean follow-up of 10.9 years,11,292 COPD hospitalization events and deaths were documented,with an overall incidence rate of 2.47/1000 person-years.Participants who consumed fresh fruit daily had a 22%lower risk of COPD-related hospitalization and death compared with non-consumers(HR=0.78,95%confidence interval[CI]:0.71-0.87).The inverse association between fresh fruit consumption and COPD-related hospitalization and death was stronger among non-current smokers and participants with normal body mass index(BMI)(18.5 kg/m^(2)≤BMI<24.0 kg/m^(2));the corresponding HRs for daily fresh fruit consumption were 0.78(95%CI:0.68-0.89)and 0.69(95%CI:0.59-0.79)compared with their counterparts,respectively.Conclusions:High-frequency fruit consumption was associated with a lower risk of COPD in Chinese adults.Increasing fruit consumption,together with cigarette cessation and weight control,should be considered in the prevention and management of COPD.